Atrial fibrillation is the most common cardiac arrhythmia and is characterized by the rapid, chaotic activity of the heart’s atria.

Based on findings from epidemiological studies, this arrhythmia is found in the general population at a rate of 0.5-1%, a rate which is expected to increase further in the coming years due to the aging of the population, but also the widespread use of newer technologies for detection her.

The symptomatology of patients with atrial fibrillation varies, with some patients being asymptomatic, while others experience mild symptoms such as palpitations, fatigue, and/or more severe symptoms such as dyspnea and syncope. In addition, atrial fibrillation is associated with an increased risk for stroke and heart failure. Therefore, treating AF and maintaining normal sinus rhythm is crucial for patients. The primary therapeutic means to reduce recurrences of atrial fibrillation is the invasive method of ablation (“ablation”) in which electrical isolation of the “arrhythmogenic” areas of the heart (mainly the pulmonary veins) is attempted. The most common ablation methods are the use of a special high-frequency current emission probe (RF ablation) and the use of a cryoablation balloon probe (Cryoablation).

Newer technologies

Newer technologies applied to the ablation of atrial fibrillation contribute to improving safety, efficiency and reducing the duration of the operation. Examples of newer technologies that are increasingly used in daily practice are Pulsed Field Ablation (PFA), very high resolution 3D electroanatomical mapping, and Intracardiac echocardiography (ICE).

1. Pulsed Field Ablation (PFA)

Pulsed field ablation (PFA) is a newer technology using which high-intensity electrical pulses are delivered through a special catheter to the atrial myocardium for a very short period of time. With this process, which is called electroporosis, very small holes are created in the cell membrane resulting in the necrosis of the myocardial cells and the interruption of communication between the left atrium and pulmonary veins. In addition, heart cells are more selectively affected than the surrounding tissues with the benefit of avoiding serious rare complications such as atrioesophageal fistula and phrenic nerve palsy.

2. Very high resolution 3D electroanatomical mapping

With the evolution of electroanatomical mapping systems, important information is offered during ablation regarding the type/focus of the arrhythmia, the left atrial substrate, but also the success of the operation. Modern electroanatomical mapping systems using special multipolar catheters provide three-dimensional images of very high definition, with the most detailed information through different colors on the course of the stimulus and the mechanism of the tachycardia (trigger mapping). Furthermore, in electroanatomical substrate mapping the colors depicted correspond to sinus potentials providing information regarding the composition of the underlying tissue (potential mapping).

Intracardiac Ultrasound (ICE)

The use of an endocardial ultrasound probe provides information about the precise anatomy of the patient’s heart contributing to the success, but most importantly, maximizing the safety of ablation. Specifically, it is a catheter that enters the heart through the femoral vein and provides high-resolution images of the heart’s structures in real time. In this way, the operation and especially the diaphragmstomy, i.e. the puncture of a thin membrane in the meso-atrial septum and the transition of the catheters from the right to the left atrium, are facilitated. In addition, it helps to monitor the position of catheters in the heart during surgery, while playing an important role in the early detection of possible complications, such as pericardial effusion and thrombus formation.

In the MITERA electrophysiological laboratory, the application of all the latest technological developments in the field of ablation contributes to the effective and safe invasive treatment of even complex cardiac arrhythmias.